Products and Enrollment Products

Benefit plans come in many variations, where part of the plan is common across plans, and part is specific to the account for which the plan is designed. In Oracle Health Insurance a benefit plan for which all options have been defined is called a product. In other words, a product is the complete package of configuration needed to adjudicate claims.

The enrollment product is a collection of benefits offered by the products. It is this level that determines the premium for enrolling on such a benefits collection, including discounts, penalties or taxes on that premium. It is also the level where a member enrolls on such a benefits collection for a certain time period.

When enrolling within the context of a group, the system allows filtering the list of available enrollment products. Enrolling within a group also allows specifying group specific premiums and adjustments for an enrollment product. The configuration at the group account level overrides the configuration at the individual enrollment product level.

An add-on provides an extension to the benefits offered by the enrollment product for a fixed price (amount or percentage) on the base premium of the enrollment product. A policy-owner can choose to extend the benefits of the enrollment product by opting for the add-on. They are additional benefits that cannot be enrolled directly.

Enrollment products allow the configuration of parameters. Parameters specifiy a 'level of service' that a member chooses for the benefits enrolled on, for example a copay amount. Premium Configuration specfies how the setting of these parameters impacts the premium to be paid. External systems like Claims can callout for these parameter values to decide how to adjudicate a claim.